Familial hypercholesterolemia affects approximately 1 in 500 people worldwide, and the elevated serum cholesterol concentrations associated with it contributes more than 50% to the risk of fatal or non-fatal coronary heart disease by age 50 in men, and at least 30% in women aged 60 and above. The prevalence of hypercholesterolemia in Jamaica is estimated at 31%. It is estimated that about 37%, or 101 million people in the United States suffer from hypercholesterolemia.
Hypercholesterolemia is implicated in many cardiovascular diseases affecting people worldwide and pose tremendous burden on the global healthcare system. In the last decade cardiovascular disease (CVD) has become the leading cause of death across the Caribbean and accounted for 19% of deaths overall in 1995. The World Health Organization report also states that coronary heart disease burden is projected to rise from around 47 million DALYs (disability-adjusted life years) globally in 1990 to 82 million DALYs in 2020 (WHO, 2004).
The major conventional drugs used to treat hypercholesterolemia include the statins (lovastatin, pravastatin, simvastatin, etc.) and niacin (nicotinic acid). Although these drugs are effective in lowering serum cholesterol levels, they cause several adverse effects. Statins, for example, cause gastrointestinal upset, muscle aches, and hepatitis. Rarer problems associated with statins include myopathy (defined as muscle pain with serum creatine kinase concentrations of more than 1000 U per liter), rash, peripheral neuropathy, and insomnia. Niacin can cause adverse effects such as flushing, abdominal pain, vomiting, headache, or elevated serum aminotransferase levels indicating liver damage.
Flavonoids are a ubiquitous family of phytochemicals that exhibit a broad spectrum of pharmacological properties. Polymethoxylated flavones are flavonoids that are almost exclusive to citrus peels and display potent anti-hypercholesterolemic, anti-cancer, anti-atherosclerotic and anti-diabetic properties.
Jamaica is the leading producer of citrus in the Caribbean. A vast majority of the citrus fruits that are harvested are used for citrus juice production, which results in large quantities of citrus peel and other citrus byproducts which end up in river beds and constitute environmental problems.